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Alcohol Abuse and Dependence

Topic Overview

Is this topic for you?

This topic is about alcohol
abuse and dependence in adults. For information about alcohol problems in teens
or children, see the topic
Teen Alcohol and Drug Abuse.

What are alcohol abuse and alcohol dependence?

Alcohol
abuse means having unhealthy or dangerous drinking
habits, such as drinking every day or drinking too much at a time. Alcohol
abuse can harm your relationships, cause you to miss work, and lead to legal
problems such as driving while drunk
(intoxicated). When you abuse alcohol, you continue to
drink even though you know your drinking is causing problems.

If
you continue to abuse alcohol, it can lead to alcohol
dependence. Alcohol dependence is also called
alcoholism. You are physically or mentally
addicted to alcohol. You have a strong need, or
craving, to drink. You feel like you must drink just to get by.

You might be dependent on alcohol if you have three or more of the
following problems in a year:

You cannot quit drinking or control how much you drink.

You need to drink more to get the same effect.

You have
withdrawal symptoms when you stop drinking. These
include feeling sick to your stomach, sweating, shakiness, and anxiety.

You spend a lot of time drinking and recovering from drinking,
or you have given up other activities so you can drink.

You have
tried to quit drinking or to cut back the amount you drink but haven't been
able to.

You continue to drink even though it harms your relationships
and causes physical problems.

Alcoholism is a long-term (chronic) disease. It's not a weakness
or a lack of willpower. Like many other diseases, it has a course that can be
predicted, has known symptoms, and is influenced by your genes and your life
situation.

How much drinking is too much?

Alcohol is part of
many people's lives and may have a place in cultural and family traditions. It
can sometimes be hard to know when you begin to drink too much.

You are at risk of drinking too much and should talk to your doctor if you
are:1

A woman who has more than 3 drinks at one
time or more than 7 drinks a week. A
standard drink is 1 can of beer, 1 glass of wine, or 1 mixed drink.

A man who has more than 4 drinks at one time or more than 14 drinks a
week.

What are some signs of alcohol abuse or dependence?

Certain behaviors may mean that you're having trouble with alcohol. These
include:

Drinking in the morning, often being drunk for long periods of
time, or drinking alone.

Changing what you drink, such as switching
from beer to wine because you think it will help you drink less or keep you
from getting drunk.

Feeling guilty after drinking.

Making excuses for your drinking or doing things to hide your
drinking, such as buying alcohol at different stores.

Not
remembering what you did while you were drinking
(blackouts).

Worrying that you won't get enough alcohol for an
evening or weekend.

How are alcohol problems diagnosed?

Alcohol
problems may be diagnosed at a routine doctor visit or when you see your doctor
for another problem. If a partner or friend thinks you have an alcohol problem,
he or she may urge you to see your doctor.

Your doctor will ask
questions about your symptoms and past health, and he or she will do a physical
exam and sometimes a mental health assessment. The mental health assessment
checks to see whether you may have a mental health problem, such as
depression.

Your doctor also may ask
questions or do tests to look for health problems linked to alcohol, such as
cirrhosis.

How are they treated?

Treatment depends on how
bad your alcohol problem is. Some people are able to cut back to a moderate
level of drinking with help from a counselor. People who are addicted to
alcohol may need medical treatment and may need to stay in a hospital or
treatment center.

Your doctor may decide you need
detoxification, or detox, before you start treatment.
You need detox when you are
physically addicted to alcohol. When you go through detox, you may need
medicine to help with withdrawal symptoms.

After detox, you focus
on staying alcohol-free, or sober. Most people receive some type of therapy,
such as group counseling. You also may need medicine to help you stay
sober.

When you are sober, you've taken the first step toward
recovery. To gain full recovery, you need to take
steps to improve other areas of your life, such as learning to deal with work
and family. This makes it easier to stay sober.

You will likely
need support to stay sober and in recovery. This can include counseling and
support groups like Alcoholics Anonymous. Recovery is a long-term process, not
something you can achieve in a few weeks.

Treatment doesn't focus
on alcohol use alone. It addresses other parts of your life, like your
relationships, work, medical problems, and living situation. Treatment and
recovery support you in making positive changes so you can live without
alcohol.

What can you do if you or another person has a problem with alcohol?

If you feel you have an alcohol problem, get help. Even if you
are successful in other areas of your life, visit a doctor or go to a self-help
group. The earlier you get help, the easier it will be to cut back or quit.

Helping someone with an alcohol problem is hard. If you're
covering for the person, you need to stop. For
example, don't make excuses for the person when he or she misses work.

You may be able to help by talking to the person about what his or her
drinking does to you and others. Talk to the person in private, when the person
is not using drugs or alcohol and when you are both calm. If the person agrees
to get help, call for an appointment right away. Don't wait.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Actionsets are designed to help people take an active role in managing a health condition.

Cause

It's not clear why some people
abuse alcohol or become
addicted to it and others do not. Alcoholism often
runs in families (genetic), but your drinking habits also
are influenced by your environment and life situations, such as friends or
stress levels.

Symptoms

Signs of alcohol abuse

You have problems at work or school because
of your drinking, such as being late or not going at all.

You
drink in risky situations, such as before or while driving a
car.

After drinking, you can't remember what happened while you were drinking (blackouts).

You
have legal problems because of your drinking, such as being arrested for
harming someone or driving while drunk (intoxicated).

You get hurt or you hurt
someone else when you are drinking.

You keep drinking even though you have health problems that are caused or made worse by alcohol use, such as liver
disease (cirrhosis).

Your friends or family members
are worried about your drinking.

Signs of alcohol dependence or addiction

You cannot quit drinking or control how much
you drink.

You need to drink more to get the same
effect.

You have
withdrawal symptoms when you stop drinking. These
include feeling sick to your stomach, sweating, shakiness, and anxiety.

You spend a lot of time drinking and recovering.

You have given up other activities so you can drink.

You keep drinking even though it harms your relationships and
causes health problems.

Other signs include:

You drink in the morning, are often drunk for long periods of
time, or drink alone.

You change what you drink, such as switching
from beer to wine because you think that doing this will help you drink less or
keep you from getting drunk.

You feel guilty after drinking.

You make excuses for your drinking or do things to hide your
drinking, such as buying alcohol at different stores.

You worry
that you won't get enough alcohol for an evening or weekend.

Signs of alcohol
problems in children and teens can be different from the ones for adults. For
more information, see the topic
Teen Alcohol and Drug Abuse.

Do you have a drinking problem?

You might not realize that you have a
drinking problem. You might not drink large amounts
when you drink. Or you might go for days or weeks between drinking episodes. But even if you don't drink
very often, it's still possible to be
abusing alcohol and to be at risk for becoming
addicted to it.

What Happens

Alcohol
abuse or
dependence can develop very quickly or happen
gradually over years.

In the beginning, your drinking might not
seem to be any different from the way other people drink. You may drink only
with friends or at parties. It may stay like this, or you may begin to drink
more. Your drinking might become a way for you to feel normal or to cope with
life's problems.

You might think that you can quit drinking at any
time. Many people who have alcohol problems quit for days, weeks, or even
months before they start drinking again. But unless you can consistently keep
your drinking under control and not fall back into unhealthy patterns, you need
help.

Problems from drinking

Long-term
heavy drinking harms your liver,
nervous system, heart, and brain. It can cause health
problems or make them worse. These problems include:

Alcohol abuse also can contribute to stomach problems,
interactions between
medicines and alcohol, and sexual problems. It can
lead to violence, accidents, social isolation, and problems at work, school, or
home. You also may have legal problems, such as traffic tickets or accidents,
as a result of drinking.

Drinking alcohol can cause unique
problems for
older adults,
pregnant women, and people who have other health
conditions. If you are pregnant, you should not drink any alcohol, because it
may harm your baby.

Drinking also makes symptoms of mental health
problems worse. When you
have a drinking problem and a mental health problem, it's called a
dual diagnosis. It's very important to treat all mental health problems, such as depression. You
may drink less when mental health problems are treated.

What Increases Your Risk

Many people drink alcohol throughout their lives without any problems. Other people who drink alcohol have problems with it. Why do some people
abuse alcohol and become
dependent on it, while others don't?

Certain things make an alcohol problem more likely. These are called risk
factors.

Genes. People with alcohol problems often have a family history of alcohol abuse and dependence.

Being male. A man is 3 times more likely to develop problems with alcohol than a woman is.

Early use. The younger you were when you first started drinking alcohol, the higher your risk for alcohol problems later as an adult.

Mental health. If you have mental health problems, such as depression,
post-traumatic stress disorder (PTSD), bipolar disorder,
schizophrenia, or
anxiety disorders, you are more likely to use alcohol.

Use of other substances. You are more likely to abuse alcohol if you abuse other things, such as tobacco, illegal drugs, or prescription medicines.

Environment. If you live in an area where alcohol is easy to get, people drink a lot, or heavy drinking is accepted as part of life, you are more likely to drink.

Friends. Your friends may influence you to drink by directly urging you to or by drinking when you're around them.

Problems with others. You may be more likely to drink when you are having problems in your family or with friends.

Not having purpose or satisfaction in your life. If you have no activities that give you a sense of purpose, you may be more likely to drink.

Just because you have risk factors for alcohol problems
doesn't mean you'll have a drinking problem. A person who has many risk factors
won't always develop alcoholism. And a person with no risk factors can become
dependent on alcohol.

When to Call a Doctor

Call 911 or other emergency services if you or someone else:

Has the symptoms of
alcohol poisoning. These can include vomiting,
coughing up blood, gasping for breath,
passing out, and
seizures.

Has a
history of heavy drinking and is having severe
withdrawal symptoms but is not willing to get
treatment.

Has
delirium tremens (DTs), which can lead to death.
Symptoms can include
seizure, shaking, a fast heartbeat, and seeing or
hearing things that aren't there (hallucinations).

Call a doctor if you're concerned that you or someone you care about may have an alcohol problem. To learn what to look for, see Symptoms.

Watchful waiting

Watchful waiting is a
wait-and-see approach. Watchful waiting is not a good choice for alcohol abuse and dependence.
If you have concerns about
your drinking or the drinking of someone you care about, talk to your
doctor. Early treatment makes recovery more likely.

Al-Anon and Alateen
(for teenagers) are for families and friends affected by someone's
drinking.

Exams and Tests

Alcohol use problems may be diagnosed during a routine doctor visit or when you see
your doctor for another problem. Many people don't go to a doctor for
alcohol problems but for problems that are caused by long-term alcohol
use.

Your
doctor will ask about your
medical history and do a
physical exam. He or she also may ask questions or do
tests to look for health problems linked to alcohol problems, such as
cirrhosis.

To learn which type of questions your doctor may ask, use this short quiz:

People who drink also may have mental health problems. These may
include
depression,
anxiety disorders, or
post-traumatic stress disorder (PTSD). If you have a
drinking problem and a mental health problem, it's called a
dual diagnosis. A dual diagnosis can make treatment for an alcohol problem
harder.

Treatment Overview

Treatment for alcohol
abuse and
dependence usually includes group therapy, one or more
types of
counseling, and alcohol education. You also may need
medicine. A
12-step program often is part of treatment and
continues after treatment ends.

Treatment doesn't just deal with
alcohol. It will help you manage problems in your daily life so you don't have
to depend on alcohol. You'll learn
good reasons to quit drinking.

Treatment helps you overcome
dependence, but it doesn't happen all at once.
Recovery from alcohol abuse or dependence—staying
sober—is a lifelong process that takes commitment and effort.

Can you quit on your own?

If you are abusing
alcohol and are not dependent on it, you may be able to
cut back or quit on your own. But most people need help when they quit
drinking.

If you want to quit, talk to your doctor. When you get a doctor's help, treatment for
alcohol abuse or dependence is safer, less painful, and quicker. If you can't stop drinking alcohol with just your doctor's help, a
treatment program can help you get through the first cravings for alcohol and
learn how to stay sober.

How does treatment start?

You might start treatment with
your family doctor, or your doctor may recommend that you enter a treatment
facility. A friend may bring you to a self-help group, such as Alcoholics
Anonymous, or you might go to a clinic that deals with alcohol abuse. You may
just decide that you drink too much and want to cut back or quit on your own.

You may have a treatment team to help you. This team may include a
psychologist or
psychiatrist, counselors, doctors,
social workers, nurses, and a case manager. A case
manager helps plan and manage your treatment.

When you first seek
treatment, you may be asked questions about your drinking, health problems,
work, and living situation. Be open and honest to get the best treatment
possible. Your treatment team may write a treatment plan, which includes your
treatment goals and ways to reach those goals. This helps you stay on track.

Do you need detox?

Your doctor may decide you need
detoxification, or detox, before you start treatment.
You need detox when you are
physically addicted to alcohol. This means that when you stop
drinking, you have physical
withdrawal symptoms, such as feeling sick to your
stomach or intense anxiety.

Detox helps get you ready for
treatment. It doesn't help you with the mental, social, and behavior changes
you have to make to get and stay sober.

Whether you need detox
and whether you can go through it at home or need to go to a clinic or other
facility depends on how severe your withdrawal symptoms are. Most people don't
need to stay at a clinic but do need to check in with a doctor or other health
professional. Whether you need to spend time in a clinic (called inpatient
care) also depends on other problems you may have, such as a mental health
problem.

Your doctor may give you medicines to help reduce
withdrawal symptoms.

What's the best treatment program for you?

Your doctor can help you decide which type of program is best
for you.

In
outpatient treatment, you regularly go to a mental
health clinic, counselor's office, hospital clinic, or local health department
for treatment.

In
inpatient treatment, you stay at a facility and have
treatment during the day or evening. This usually lasts 1 to 6 weeks. You most
likely will then go to outpatient treatment.

In residential treatment, you live at the facility
while you recover. These programs may last for months. This may be a good option if you have a long history of
alcohol or drug use, have a bad home situation, or don't have social support.

If you are thinking about going into a treatment program,
here are some
questions to ask.

What does a treatment program include?

Counseling

Treatment
programs usually include
counseling, such as:

Individual and group therapy, where you talk about your
recovery with a counselor or with other people who are trying to quit. You can
get support from others who have struggled with alcohol.

Cognitive-behavioral therapy (CBT), where you learn to
change thoughts and actions that make you more likely to use alcohol. A
counselor teaches you ways to deal with cravings and avoid going back to
alcohol.

Motivational interviewing (MI), where you resolve
mixed feelings about quitting and getting treatment. A counselor helps you find
personal motivation to change.

Motivational enhancement therapy (MET), which uses
motivational interviewing to help you find motivation to quit. It usually lasts
for 2 to 4 sessions.

Brief intervention therapy, which provides feedback,
advice, and goal-setting in very short counseling sessions.

Couples and
family therapy, which can help you become and stay
sober and keep good relationships within your family.

Medicine

A treatment program may include medicines that can help
keep you sober during recovery. You may take medicine that can help reduce your craving for alcohol or that makes you sick to your stomach when you drink.

Education

Most programs provide education about alcohol abuse and
dependence. Understanding alcohol problems can help you and your family know
how to overcome them. Some programs also offer job or career training.

Support groups

Treatment programs often include going to a support group, such as
Alcoholics Anonymous (AA). Your family members also
might want to attend a support group such as
Al-Anon or Alateen.

What else should you think about?

If you have an alcohol problem and a mental
health problem, such as depression, you will need treatment for both problems.
Doctors call this a
dual diagnosis.

Some people are sent to alcohol treatment because of a court
decision. This may happen if you have an alcohol problem and you commit a
crime. A court may require treatment and keep track of your progress. Treatment
often is available in prison.

Medications

Medicines can be used to help treat
alcohol
abuse and
dependence. Some medicines reduce
withdrawal symptoms during
detoxification. Other medicines help you stay sober
during the long process of
recovery.

Medicines for withdrawal

Medicines most often used to
treat withdrawal symptoms during detoxification include:

You also might need supplements
to help replace fluids and
electrolytes.

Recovery

Recovery from
alcohol
abuse or
dependence means finding a way to stay sober while
changing your attitudes and behaviors. You will work to restore relationships
with your family and friends and people at your job or school. You will need to
find meaning and happiness in a healthy lifestyle that doesn't include alcohol.

Recovery is not a cure. It is a lifelong process. It begins in
treatment, but it doesn't end when your treatment ends. There are
10 principles of recovery(What is a PDF document?) that can help you reach your goals and learn new things to
help yourself. They help you gain self-confidence and respect for yourself.
They make clear that you're in charge of your recovery. How far you go is up to
you.

Connect with family and friends. They can help you stop
drinking and stay sober by encouraging positive steps. For them to do this, you
have to be honest with them about your problems and help them by
trying.

Take part in recovery group activities. You may have used
alcohol to make friends or be with a social group. Your counselor or doctor can
help you learn skills to make friends without drinking. For example, your
counselor may help you find a social skills training class.

Find a
sponsor, and work with this person. A sponsor is
someone who has been in recovery for a long time and helps you stay
alcohol-free.

Plan for lapse and relapse

Stopping alcohol use is very hard. It's not unusual to have
setbacks, even years later. Very few people succeed the first time they try.
Many people who are trying to recover from alcohol addiction will have lapses
or relapses along the way.

A lapse is the first time you use alcohol
again after you have quit or brief episodes of alcohol use at later points.

Deal with stress

Some people find that
relieving stress helps them during recovery. Although
there is little research to show that managing stress helps you stay sober, you
may find that it helps you feel better overall.

You can find ways to deal with stress, such as sharing your feelings with others or writing to express your journey through recovery. Do something you enjoy, like a hobby or volunteer work. Learn how to relax your mind and body with breathing exercises or meditation.

You can do many things to reduce stress. To learn more, see the topic
Stress Management.

Have a healthy lifestyle

When you abuse or are dependent on alcohol, you often get away
from some of the basics of good health. Part of recovery is finding your way
back to a healthy lifestyle.

Exercise and be active. This may give
you something to do instead of thinking about alcohol, and it also can help
reduce stress. People who are fit usually have less anxiety, depression, and
stress than people who aren't active.3

Eat a balanced diet. This helps your body deal with tension and stress. Whole
grains, dairy products, fruits, vegetables, and protein are part of a balanced
diet.

Talk to your family about your drinking

Alcohol
abuse or
dependence can harm your relationships with family and
friends. You and your family may feel you have turned against each other. You
may be angry at your family and friends, and they may be angry at you.

If you can, talk with your family and friends about your drinking
problem and
recovery. Your family and friends need to know that
they did not cause your alcohol problem but that they can help you during recovery.

Try to be open and honest with loved ones
about your drinking. This will help them understand what you're going through
and how they can help. Many treatment programs offer
counseling for families to help you solve problems at
home.

For Family and Friends

If someone close to you has had a drinking problem, you know how
hard it can be. You know how living or dealing with someone who abuses or is
dependent on alcohol can change and even destroy your life. You're an important part of your loved one's treatment and recovery. Your emotions and life may change too, and taking care of yourself is also important.

Encourage treatment

It can
be very hard to live with a family member who has a drinking problem. It's best
not to try to control, excuse, or cover up the person's drinking. Instead,
encourage your family member to seek treatment. Find a good time to talk to the person.

Help with treatment and recovery

When
the choice for treatment has been made, you play an important part. You can
help your loved one stop drinking and help repair the damage done to your
family or relationship. Here are some things you can do:

If you drink, decide whether you want to keep
alcohol in the house. Having alcohol in your home might make it harder
for your loved one to stay sober.

Be involved and patient. Attend
recovery meetings with your loved one, and be supportive. Know that it may take
a long time for you to trust and forgive the person and for the person to
forgive himself or herself.

Be aware that your loved one may seem
like a different person after he or she is sober. You may find it hard to get
used to this person. You may need to rebuild your
relationship.

Understand that you have the right to know how
recovery is going, but ask about it in a respectful way.

Help your loved one plan for a relapse. Most people
relapse after treatment. This doesn't mean the treatment failed. Try to help
your loved one see relapse as a chance to do better and to keep working on skills
to avoid drinking.

Focus on the positive actions your loved one is
making.

Take care of yourself

Taking care of yourself while you help your loved one is
important. You probably will feel relief and happiness when the person decides
to get help. But treatment and recovery mean changes in your life too. Your
emotions may become more complicated. You may:

Resent what the person did to you in the
past.

Not trust the person. You may not want to give the person the
house key, the car key, or money. You also may feel guilty about not trusting
the person.

Find it hard to give up or share your family role. For
example, if you took over child-rearing when your partner was drinking, you may
resent his or her becoming involved again. If you managed money, you may resent
having to make shared decisions on how to spend money.

Resent that
the person is spending more time at meetings or with others in recovery than
with you.

Worry so much about relapse that you avoid anything that you
think may upset the person. You also may resent this feeling.

These feelings are normal. You've been through a bad
period of your life, and what happened is not easy to forget. Nor is it easy to
forgive your loved one. Keep in mind that recovery is the road to a better life and
that you can help your loved one get there.

Find your own support

You may find that talking to people who also have loved ones with alcohol problems helps your own recovery. Al-Anon and similar programs are for people with
family members or friends with alcohol problems. Other support groups are
specially designed for certain age groups, such as Alateen for teens and Alatot for
younger children.

These programs help you recover from the
effects of being around someone who abused or was dependent on alcohol. You
also may try
family therapy.

Other Places To Get Help

Organizations

Centers for Disease Control and Prevention: Alcohol and Public Health (U.S.)

Web Address:

www.cdc.gov/alcohol/index.htm

National Council on Alcoholism and Drug Dependence, Inc. (NCADD) (U.S.)

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